- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $7,364.91
| Facility | | $3,706.14 | $3,955.04 | $7,364.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.31 / $455.12 / $2,440.77
| Professional | | $195.31 | $455.12 | $2,440.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.20 / $604.02 / $2,957.22
| Professional | | $364.20 | $604.02 | $2,957.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.16 / $803.48 / $4,100.37
| Professional | | $219.16 | $803.48 | $4,100.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $4,086.00 / $9,622.00
| Facility | | $2,838.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,228.62 / $2,658.14 / $4,601.26
| Professional | | $2,228.62 | $2,658.14 | $4,601.26 |